In December, the AMA House of Delegates resolved to stop drug companies from profiling physician prescribing patterns. The profiles are used to target and market drugs to doctors.
Nonetheless, the AMA continues in the lucrative business of selling to drug marketers the asociation's comprehensive list of physicians that contains key Drug Enforcement Agency physician ID numbers.
If that apparent contradiction isn't enough, officials from the AMA and the drug industry agree that drug marketers really don't need the data they're apparently paying millions of dollars to obtain from the AMA. They're buying the data, at least in part, to make friends with the physician group.
AMA delegates last year asked their leaders to use all "legally appropriate means" to prevent drug companies from profiling doctors' prescription writing habits, including ending the use of a physician's DEA number "as a pharmaceutical marketing tool."
The resolution claimed physician drug profiling is "an inappropriate intrusion into the privacy of the physician-patient relationship." Yet a list of physicians that includes DEA numbers makes it easy for a drug marketer with a computer database to link prescriptions to the doctors who wrote them.
"Privacy is privacy," says Ron Weich, a legislative consultant for the American Civil Liberties Union in Washington.
The ACLU is lobbying hard to close a loophole in the regulations of the Health Insurance Portability and Accountability Act that privacy advocates say will enable drug companies to use computerized, confidential patient prescription information to market to patients.
"Doctors need to be careful that their business practice does not inadvertently violate patient confidentiality," Weich says. "This (list selling) practice appears to endanger patient confidentiality, at least indirectly."
Not surprisingly, AMA officials disagree.
Their list, the AMA Physician Masterfile, does not include prescription or patient information, they insist. And, although a version of the list includes physician DEA numbers, purchasers of that information must abide by a written agreement limiting what they do with the data, says Mark Frankel, the AMA official in charge of database licensing.
"Our guidelines say this information can only be used for direct sales or sampling of drugs," Frankel says. And since the AMA data is leased, not sold, a drug company can lose future access to the list if it violates AMA guidelines.
Only a dozen or so drugmakers and drug marketers use the AMA list, Frankel says. Most pharmaceutical companies get their information about doctors elsewhere.
"We haven't empowered them. They already have the data. They would do this with us or without us," he says.
That is true, to a point. A list of doctors, their addresses and their DEA numbers can be purchased from the National Technical Information Service, a division of the Commerce Department, for $270.
Kathy Friedman, spokesperson for IMS Health of Philadelphia, the world's largest marketer of prescription drug information, says her company pulls physician information "from a multitude of sources," including the AMA.
But, Friedman says: "They're not essential to us. We could do without them."
Jeanne Scott, director of government relations for NDC Health of Atlanta, also an AMA customer, says the government's DEA list, while far less expensive, is not as up-to-date as the AMA's "very comprehensive and complete list." AMA's ties to medical schools enable it to identify and profile even first-year medical students, Scott says.
But Scott also says, for her company, "there are good, internal political reasons for doing business with the AMA." NDC sells medical software as well as physician drug profiles. "We love the AMA. We want us to be considered partners with doctors. It's a small price to pay."
The Medical Marketing Service, of Wood Dale, Ill., has been reselling data for the AMA since 1929. MMS also markets the NDC Power Profiler, which includes data from 34,000 pharmacies and shows prescribing behavior for about 94% of prescribers.
The AMA remains secretive about the royalties collected on the lease of its Physician Masterfile. The AMA's tax returns for 1999 show nearly $30.5 million, or 14% of total revenue, came from royalties.
The AMA also charges royalties for the use of its Current Procedural Terminology code sets. The AMA refused to break out these revenues.
To enforce the AMA resolution on DEA numbers, Bob Musacchio, senior vice president of publishing and business services at the AMA, has been meeting with leaders of the pharmaceutical industry to express physicians' concerns.
Musacchio says he has made it clear to them that "they're jeopardizing their future by certain practices."